COELIAC DISEASE AND A GLUTEN FREE DIET - Information Leaflet
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COELIAC DISEASE AND A GLUTEN FREE DIET Information Leaflet Your Health. Our Priority. www.stockport.nhs.uk Nutrition and Dietetics | Stockport, Tameside and Glossop
Page 2 of 13 This leaflet should only be used following assessment by a dietitian Introduction This leaflet provides general information about food choices if you have coeliac disease. It will help you take steps to follow a gluten free diet which may protect your long term health and reduce symptoms if any. What is Coeliac Disease? Coeliac disease is an autoimmune condition. It isn't an allergy or intolerance to gluten; instead, the immune system mistakes gluten as a threat to the body and attacks it. This damages the surface of the small intestine by flattening the small, finger-like projections called villi, which help us to absorb the nutrients from food. It is more common in people who also suffer from other autoimmune diseases such as Type 1 diabetes and autoimmune thyroid problems. Dermatitis Herpetiformis Dermatitis Herpetiformis is a skin condition that is related to coeliac disease. Treatment for this condition is also a gluten free diet for life. What is Gluten? Gluten is a protein found in some cereals and grains including wheat, rye and barley. A similar protein is found in oats (oats are discussed in detail at a later stage). Why should I have a gluten free diet? Eating foods containing gluten can cause symptoms such as bloating, diarrhoea, nausea, tiredness and headaches. Some people do not experience any symptoms but it is still important to follow a gluten free diet. It is important to follow a gluten free diet to: Avoid symptoms Prevent nutritional deficiencies Prevent longer term complications When coeliac disease is undiagnosed and untreated it means that the body cannot absorb nutrients properly e.g. iron and calcium. Anaemia and Iron Due to not being able to absorb iron properly you may be at risk of iron deficiency, known as anaemia. It is important to ensure you are including sources of iron in your diet each day. www.stockport.nhs.uk Nutrition and Dietetics | Stockport, Tameside and Glossop
Page 3 of 13 Osteoporosis and Calcium Similarly calcium may not be properly absorbed and you may be at risk of developing osteoporosis, a condition where bones become brittle and thin. When you are first diagnosed with coeliac disease, you may be offered a DEXA (or bone scan). Lactose Intolerance Lactose intolerance can be associated with coeliac disease as lactase, the enzyme that breaks down lactose, is produced in the gut. When the gut is damaged this enzyme is not made properly. Small Bowel Cancer There is a higher risk of developing small bowel cancer when you have coeliac disease due to damage to this part of the bowel. However once the gluten free diet has been followed for 3-5 years and the gut has been allowed to heal, the risk of developing this type of cancer is similar to people who do not have coeliac disease. What foods can I eat and what foods should I avoid? There are many naturally gluten free foods which you can eat freely. These include: Meat, fish and chicken Cheese, milk and yoghurt Fruit and vegetables Potatoes and rice These foods are only gluten free in their natural form. If they have any ingredients added to them it is important to check the label to ensure they are gluten free. Some foods will always contain gluten and need to be avoided. All foods containing wheat, rye and barley need to be avoided. Oats Oats contain avenin which is a protein similar to gluten. Most people with coeliac disease can safely eat gluten free oats. Standard oats need to be avoided as they are often produced in the same place as wheat, barley and rye and can become contaminated. A very small number of people with coeliac disease may still be sensitive to gluten-free, uncontaminated oat products and may have ongoing symptoms. Gluten-free oats may be introduced to the diet at diagnosis but if you have ongoing symptoms it is best to discuss their use with your dietitian. Some foods may or may not contain gluten and it depends on what ingredients have been added. For this reason it is very important to always check the food label to see if it contains gluten. On the next few pages we have provided a table which will give more guidance on common foods and what foods you can eat freely, avoid or need to check the label. www.stockport.nhs.uk Nutrition and Dietetics | Stockport, Tameside and Glossop
Page 4 of 13
Bread, rice potatoes, pasta and other starchy foods
This category of foods contains all the starchy foods and is the food group where gluten is often
found. All foods containing wheat, barley and rye need to be avoided. Potatoes and rice are
gluten free unless processed. All processed foods should be checked to see if they are gluten
free.
Check labels
Choose Avoid
or Directory
Corn, rice, quinoa, Wheat, bulgar wheat,
buckwheat, millet, durum wheat, wheat
polenta, sago, tapioca bran, wheat rusk,
Non wheat based flours wheat starch, wheat
e.g. corn, rice, potato, flour, modified wheat
Flavoured, savoury rice
Cereals & soya, gram flour starch, semolina,
products.
Flour (chickpea), arrowroot, couscous, barley,
amaranth, teff, sorghum, barley malt, barley
potato starch, modified flour, rye flour, rye,
starch, cassava. Gluten triticale, Khorasan
free flours and mixes. wheat (Kamut) spelt.
All breads, rolls,
Gluten-free breads and muffins, chapattis
Bread rolls. made from wheat, rye
or barley flour.
All products labelled as
Buckwheat, corn, millet and
gluten-free or ‘Free Wheat based
rice based breakfast cereals
From’ gluten including breakfast cereals,
Breakfast and those that contain barley
millet porridge, muesli. Oats not
Cereals malt extract. Oats (check if
buckwheat flakes, labelled gluten free.
gluten free).
muesli.
Pizza bases made
All products labelled
from wheat, rye or
gluten-free including
barley flour.
corn (maize) pasta,
Pizza, Pasta
quinoa pasta, rice
& Noodles Fresh, dried and
noodles, rice pasta and
canned wheat pasta
gluten free pizza bases.
or noodles.
Potato products in
Potato products - chips
All plain potatoes, batter, breadcrumb or
(deep-fried, oven, microwave
baked, boiled or containing flour e.g.
Potatoes and frozen), instant mash,
mashed. hash browns, potato
waffles.
cakes.
www.stockport.nhs.uk Nutrition and Dietetics | Stockport, Tameside and GlossopPage 5 of 13
Meat, fish, eggs, beans and other non-dairy sources of protein
Many of these products are naturally gluten free but some will need to be avoided eg some
processed foods. See table below.
Choose Check labels or Directory Avoid
Meat and poultry
All fresh meats and
cooked in batter or
poultry, smoked meats,
breadcrumbs, faggots,
cured pure meats, plain Meat pastes, pates,
rissoles, haggis,
cooked meats. All fresh, sausages, burgers. Fish in
Meat and breaded ham. Fish in
smoked, kippered and sauce, fish pastes and
Fish batter or breadcrumbs,
dried fish, fish canned in pates.
fish cakes,
oil, brine or water,
taramasalata and fish
shellfish.
fingers.
All pulses (beans peas Pulses in sauce such as
Pulses & and lentils). All plain and baked beans. Dry roasted
Nuts salted nuts. nuts.
Marinated tofu, vegetarian
Plain tofu, dried soya burgers and vegetarian
Vegetarian
mince. ready meals, Quorn
Alternatives
products.
All plain eggs. Scotch eggs.
Eggs
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Milk and dairy foods
Most dairy products are naturally gluten free. Exceptions are listed below such as yoghurts with
cereal added, and oat milk.
Choose Check labels or Directory Avoid
Plain milk - cows’,
sheep, goats’, soya. All
cream (single, double, Coffee and tea whiteners. Milk with added fibre.
Milk, whipping, clotted, Flavoured yoghurt, fromage Yoghurt and fromage
Yoghurt & soured and crème frais or soya desserts. frais containing muesli
Cream fraiche), buttermilk, plain Rice milk. or cereals. Oat milk.
yoghurt, plain fromage
frais.
Some soft, spreadable
Most cheeses. cheese. Speciality cheese
Cheese
such as caboc.
www.stockport.nhs.uk Nutrition and Dietetics | Stockport, Tameside and GlossopPage 7 of 13
Fruit and Vegetables
All non-processed fruit and vegetables are naturally gluten free. However some fruit and
vegetable products contain gluten depending on how they have been processed e.g. those in
batter or breadcrumbs.
Choose Check labels or Directory Avoid
Fruit pie, sponge,
All fresh, frozen,
crumble or fruit in
canned, juiced and Fruit pie fillings.
Fruit batter for example
dried pure fruits.
fritters.
All fresh, frozen,
canned, dried and
Ready-made or pre-packed, Vegetables in batter,
juiced varieties.
for example coleslaw. breadcrumbs or dusted
Vegetables pickled in
Vegetables in sauce or with flour, for example
Vegetables vinegar.
gravy, for example vegetable pasties,
All peas including
cauliflower cheese. onion rings.
mushy, processed and
marrowfat.
www.stockport.nhs.uk Nutrition and Dietetics | Stockport, Tameside and GlossopPage 8 of 13
Foods and drinks high in fat and/or sugar
This category of foods often contains a lot of processed products which need to be checked
individually to see whether they contain gluten or not. Most cakes, biscuits, desserts and
savoury snacks contain gluten and need to be avoided. Gluten free varieties of these foods are
widely available.
Choose Check labels or Directory Avoid
Butter, margarine, lard,
cooking oils, ghee,
Suet.
Fats & Oils reduced and low fat
spreads.
Homemade popcorn, Snacks made from
Savoury rice cakes, rice Potato crisps. wheat, rye or barley e.g.
Snacks crackers. pretzels.
All cakes, pastries,
Gluten free cakes and scones made with
Cakes & Meringues, macaroons.
biscuits. wheat, rye or barley
Biscuits
flour.
Puddings made using
Ice cream, sorbet, mousse, wheat flour, and/or
Puddings & Jelly. custard, rice pudding, semolina, for example
Desserts pavlova, panna cotta. crumbles, pies, sponges
and trifles.
Sugar, molasses, jam,
Mincemeat, lemon curd,
conserves, honey,
Sugars, peanut and other nut
golden syrup, treacle,
Preserves & butters, chocolates,
marmalade, liquorice
Sweets liquorice sweets.
root, seaside rock.
www.stockport.nhs.uk Nutrition and Dietetics | Stockport, Tameside and GlossopPage 9 of 13
Drinks and Miscellaneous
Most soups, sauces, gravies and seasoning contain a wide variety of ingredients and it is best
to check each product individually to see whether it is gluten free or not. Many alcoholic drinks
contain gluten also in addition to malted and barley drinks and need to be avoided.
Choose Check labels or Directory Avoid
Tomato and garlic
puree, individual Gravy granules, stock cubes,
Soup containing
herbs and spices, canned or packet soups, packet
barley, or broth
mixed herbs and and jarred sauces and mixes, soy
mixes, noodles or
Soups, Sauces, spices, ground sauce (including Tamari)
croutons.
Gravies & pepper, mint sauces, Mustard products, mayonnaise,
Chinese soy
Seasoning vinegars (including salad cream, dressings, pickles
sauce.
barley malt vinegar), and chutney, blended seasoning,
Stuffing mix.
Worcestershire curry powder.
sauce.
Artificial sweeteners,
icing sugar, glucose
syrup, gelatine,
bicarbonate of soda,
Ready to use icing, cake
cream of tartar, fresh Ice cream cones
decorations, marzipan. Baking
Miscellaneous and dried yeast. Beef, and wafers.
powder.
chicken or yeast
extract, Complan
Shake or
Build-up/Meritene.
Water, tea, coffee, Malted milk drinks,
Drinking chocolate, fizzy drinks,
cocoa, fruit juice, barley
Soft Drinks vending machine hot chocolate.
squash. waters/squash.
Wine, spirits including
malt whisky, cider, Beer, lager, stout,
Alcohol sherry, port, liqueurs, ales.
gluten free beers.
www.stockport.nhs.uk Nutrition and Dietetics | Stockport, Tameside and GlossopPage 10 of 13
Buying gluten free and prescriptions
Buying Gluten Free
Gluten free products are often available in supermarkets. Many supermarkets sell gluten free
ranges of breads, pastas, cakes and biscuits which you can purchase and include in your diet.
Food labels can be used to identify gluten free foods. All foods containing gluten should have it
marked in bold writing on the food label.
Prescriptions
Some gluten free products are available on prescription. These are prescribed in units and
foods available include bread, flour, pasta and cereal. Prescriptions are paid for by patients
unless you qualify for free prescriptions. If you do need to pay for your prescription a pre-
payment certificate can be bought once a year to reduce cost. For more information on how to
order a prescription please speak to your dietitian or GP.
Practical Tips
Cross contamination
It is extremely important to avoid even small amounts of gluten accidentally getting into your
food. This is called cross contamination. Taking the following steps can help to reduce this risk:
Use a separate toaster or toaster bags to keep gluten free bread separate from crumbs. This
also applies to toasted sandwich makers.
Have separate jars of jams or spreads to avoid gluten contamination through crumbs.
Use a different bread/chopping board for gluten containing and gluten free foods.
Wipe gluten containing flour off surfaces thoroughly or prepare gluten containing foods on
cling film to ensure cleanliness.
Thoroughly cleaning kitchen utensils and equipment.
Eating out
It is good to talk to friends and family about your coeliac disease. This helps everyone to learn
about a gluten free diet and means they can help provide you with gluten free meals. Often
some planning is needed before going out for a meal or buying a takeaway.
Call restaurants ahead of time and explain about your dietary needs and the consequences
for you if you eat gluten. Speak to the chef or cook to avoid confusion when you arrive and to
help them prepare for your visit.
Ask how foods are prepared and check that they understand to keep the gluten containing
and gluten free foods separate.
Cooking tips
Normal recipes can be changed to use gluten free alternatives. Baking foods such as bread,
cakes and biscuits can take some practice to get right. These types of food sometimes require
extra fluid – having a few trials is often necessary.
www.stockport.nhs.uk Nutrition and Dietetics | Stockport, Tameside and GlossopPage 11 of 13
Gluten free pastry often requires the addition of an egg to handle the pastry. Xanthan gum can
also be used to improve the texture of gluten free products, it can be found in most
supermarkets or health food shops.
Medicines
All prescribable medicines listed in the guides used by your doctor are gluten free.
Non-prescribable medicines that have a product license number (PL) on the packet are also
gluten free.
If you are concerned about this, please check this with your doctor or pharmacist.
Additional Information
Coeliac UK is a charity for people with coeliac disease and dermatitis herpetiformis.
They provide information and support to both children and adults with coeliac disease.
Members are provided with an annual food and drink directory containing around 10,000
foods and drinks which are gluten free.
A membership option is available by postal form or online for a small yearly payment.
Contact details
Coeliac UK, 3rd Floor, Apollo Centre, Desborough Road, High Wycombe, Buckinghamshire,
HP11 2QW
Website: www.coeliac.org.uk
Telephone: 0149 443 7278
www.stockport.nhs.uk Nutrition and Dietetics | Stockport, Tameside and GlossopPage 12 of 13 Contact us Please contact your Dietitian on the contact number below: Tameside and Glossop contact details Community Dietitian- Tameside and Glossop Selbourne House Union Street Hyde SK14 1NG Tel: 0161 366 2346 The service is available Monday- Friday, 8:30am-4:30pm Dietitians- Tameside Hospital Based Tameside General Hospital Fountain Street Ashton-u-Lyne OL6 9RW Tel: 0161 331 5164 The service is available Monday- Friday, 8:30am-5:00pm Stockport contact details Community Dietitian- Stockport Floor 9 Regent House Heaton Lane Stockport SK4 1BS Tel: 0161 426 5975 The service is available Monday-Friday, 9:00am-5:00pm Your Dietitian is: _________________________ If you would like to make any suggestions or complaints please contact our Patient & Customer Services: Tel: 0161 419 5678 Fax: 0161 419 5296 Email: pcs@stockport.nhs.uk Website: www.stockport.nhs.uk www.stockport.nhs.uk Nutrition and Dietetics | Stockport, Tameside and Glossop
Page 13 of 13 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: 0161 419 5678. Email: PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number TG81 Publication date August 2015 Review date August 2017 Department Nutrition and Dietetics Location Stockport, Tameside and Glossop www.stockport.nhs.uk Nutrition and Dietetics | Stockport, Tameside and Glossop
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